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Jean-Jacques Muyembe Tamfum News Jean-Jacques Muyembe Tamfum: a life’s work on Ebola Jean-Jacques Muyembe Tamfum was part of the research team that investigated the first known outbreak of Ebola virus disease in 1976. He talks to Fiona Fleck about those experiences and how he and his colleagues are using the knowledge they have built up in recent Ebola outbreaks. Q: How did you become interested in epidemiology? Jean-Jacques Muyembe Tamfum has devoted the last A: After graduating in medicine, I four decades to researching Ebola virus disease. He decided to do a PhD in virology at the worked on the World Health Organization (WHO) team University of Leuven in Belgium where I that implemented detection and control measures in started to do some research in the treat- the first documented urban outbreak of Ebola in Kikwit ment of viral infections, working with in 1995 in the Democratic Republic of the Congo. mice, but when I went back to Congo, at that time called Zaïre, I was unable Muyembe is Director-General of the National Institute to pursue my work, because there were for Biomedical Research and Professor of Microbiology WHO no labs there and no laboratory animals. Jean-Jacques Muyembe at Kinshasa University Medical School in the Democratic That year, 1974, there was a cholera out- Tamfum Republic of the Congo. He worked at the Institut Pasteur break in the Port of Matadi, and I was de Dakar in Senegal in 1981 and the US Centers for dispatched to investigate. The following Disease Control and Prevention in 1981 in the Special Pathogens Branch for year I was sent to investigate an outbreak the study of Ebola and Marburg viruses and has chaired several international of bacterial meningitis that was killing committees for the control of Ebola outbreaks. He was appointed dean of the a lot of soldiers in the military camp of Faculty of Kinshasa University Medical school in 1978, having received his PhD Kitona in the Kongo central province. in virology from the University of Leuven in Belgium (1973) and graduated in I went to the location, and isolated the medicine from the University of Lovanium in Kinshasa (1969). bacteria. The government launched a vaccination campaign, and that was the end of the epidemic. from Kinshasa with medicine. Many of Q: It’s amazing that you survived. them had fever and diarrhoea. I thought A: Yes, it is extraordinary. If I had they perhaps had typhoid fever, and I not washed my hands, I would have If I had not collected blood samples. But I noticed died. After Yambuku there were no more washed my hands, I that when I removed the needle from outbreaks for a long time. Then, in 1995, “ people’s arms, the puncture wounds I got a call from the director of Kikwit would have died. bled a lot. My fingers and hands were General Hospital saying that there had covered in blood. So I used water and been an outbreak of bloody diarrhoea ” soap to wash it off. that had already caused several deaths. I also got a message from the Diocese Q: You didn’t wear gloves? of Kikwit asking me to come and help. I Q: So was that how you started to work A: Back then, we used our bare suspected that it was shigellosis or some- on outbreak investigations? hands, we had no protective clothing. thing like that and that I could resolve A: Yes, those two experiences made Later, I took some liver samples from the problem quickly, so I left with only me realise that I couldn’t just study mi- two corpses, using a steel rod and so of two pairs of trousers. When I got there, crobes in the laboratory, but needed to course there was even more blood, and however, and had a look around, I re- get into the field. Then, in 1976, there again I washed with soap and water. alised it was not shigellosis. It was Ebola. was an outbreak of a mysterious disease The liver biopsies were inconclusive, And Kikwit was different to Yambuku; at a Catholic mission run by Belgian but then I examined a Belgian nun this was a town, not a village, so the risk nuns in Yambuku, in the north of the who had developed a fever, and I said of the disease spreading was far greater. country. The health minister sent me and to her, “since we don't know how to People said to me, how can it be Ebola? Dr K Omombo to take a look. Yambuku diagnose this disease, I'm going to take We are at least 1000 kilometres away was a remote village in the forest and you to Kinshasa.” She said: “I can't leave from Yambuku. But I was quite sure. when I arrived, the place was deserted. because they're going to think that I'm So, I collected samples and sent them to It was as if nobody lived there. It was escaping because of the disease.” Finally, the Centers for Disease Prevention and the same at the hospital. Most of the we persuaded her and we left. When we Control through the Institute of Tropical nurses were dead, and all the patients got to Kinshasa, we took a blood sample Medicine in Antwerp. Two days later, had fled except for one patient, a child. from her and sent it to the Institute of they confirmed that it was Ebola. The mother said the child had malaria, Tropical Medicine in Antwerp (Bel- but then the child died in the night. gium) where Peter Piot worked. It was Q: What happened then? The next day villagers showed up at the from the blood of this nun that Piot first A: There was complete panic, but hospital. They’d heard that we had come isolated the Ebola virus. I started setting up teams to care for 804 Bull World Health Organ 2018;96:804–805 | doi: http://dx.doi.org/10.2471/BLT.18.031218 News the patients at the hospital. I met with research into the reservoirs of the virus, metres, much of it inaccessible by road. a group of doctors and asked who was because we still don’t know where Ebola So even without the kind of conflict and ready to go into quarantine with the comes from. For a long time we thought instability that we have experienced, patients. Nobody looked at me, but after that bats were the reservoir, but we’ve surveillance is a challenge. The country a few minutes one of them got up and examined thousands of samples and is divided into 516 health zones and we said “I am.” He was a young doctor. I said haven’t found it. So we must continue have a surveillance system in each zone. “Are you sure? You will be put in isola- to search. Community volunteers report health tion and won’t be able to leave for at least events in their villages, and these reports 48 hours.” He agreed. So did the nurses. are collected at the central level. When That was the beginning of the emergency The biggest a health event is considered potentially response. Then WHO was notified and challenge is the significant, the province dispatches sent experts led by Dr David Heymann “ epidemiologists who can investigate and to join us. I led the response to the epi- security situation. collect samples. Unfortunately, it can demic, which eventually killed at least take a week for the sample to arrive at 254 people. Since then, of course, more ” our institute. That’s why we are planning Ebola outbreaks have occurred in my to build labs in each province. country, in 2007, 2008, 2009, 2012, 2014, 2017 and now two in 2018. I have been Q: You have also helped set up research Q: What are the main challenges with present at all of them. I’ve spent all my facilities. Can you tell us about how you the current Ebola outbreak? life and my entire career fighting Ebola. came to participate in the construction A: We are facing many challenges of your research institute? to end this outbreak. The biggest chal- Q: How do you use the knowledge you’ve A: That is a long story. It starts back lenge is the security situation, which is acquired over all these years to fight in 1975 when the Minister of Health characterized by the presence of several against the Ebola epidemic today? asked me to develop the design for an active armed groups, the lack of commu- A: I and my colleagues have given institute like the Pasteur Institute in nity engagement in some places, and the presentations at more than 50 confer- Paris. At first I was only involved in the geographic spread of the transmission in ences. We’ve also published a number design process. Then in 1998, I was ap- multiple foci. of papers. However, my most significant pointed director-general of our National contribution to the fight against Ebola Institute for Biomedical Research. WHO Q: How is your country managing the virus disease may be my work on the use set up its polio research laboratory here outbreak? of antibodies as the basis for therapeutic in 1988 and then the CDC added its A: We have put in place strategies medicines, a line of inquiry that is based influenza lab. I also got a mobile lab that have been successful in previous on observations made during the Kikwit which has been paid for by United States outbreaks: early detection of cases, epidemic.
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